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Current Vascular Pharmacology Apr 2009Vascular embolisation agents are particles or fluids that can be released into the bloodstream through a catheter to mechanically and/or biologically occlude the target... (Review)
Review
Vascular embolisation agents are particles or fluids that can be released into the bloodstream through a catheter to mechanically and/or biologically occlude the target vessel, either temporarily or permanently. This definition excludes vessel-blocking agents or devices such as balloons and coils, which are positioned at the target site, as opposed to released in the bloodstream. Vascular embolisation agents are available as solids, liquids and suspensions. Careful selection of the agent based on the size and calibre of the target vessel ensures that the occlusion is confined to the desired site. In this review, we discuss the 2 main categories of embolisation agents: particles (either non-spherical or microspherical), which are the most widely used; and liquids (glues, gels, sclerosing agents and viscous emulsions). For each agent, we review the characteristics, mechanisms of action, main indications and modalities of use, advantages and drawbacks. The use of embolisation in clinical practice requires a thorough understanding of the behaviour (rheology and vascular topology) and biocompatibility of each agent. To improve the accuracy of targeting, we need new, more sophisticated, bioactive agents, which are being developed.
Topics: Catheterization; Embolization, Therapeutic; Gelatin Sponge, Absorbable; Humans; Microspheres; Neoplasms; Polyvinyl Alcohol; Rheology; Sclerosing Solutions; Tissue Adhesives
PubMed: 19356008
DOI: 10.2174/157016109787455617 -
Interventional Neuroradiology : Journal... Dec 2019Intracranial aneurysms are increasingly being treated by the placement of flow diverters; however, the factors affecting the outcome of aneurysms treated using flow...
BACKGROUND
Intracranial aneurysms are increasingly being treated by the placement of flow diverters; however, the factors affecting the outcome of aneurysms treated using flow diverters remain unclarified.
METHODS
The present study investigated 94 aneurysms treated with pipeline embolisation device placement, and used a computational fluid dynamics method to explore the factors influencing the outcome of aneurysms.
RESULTS
Seventy-six completely occluded aneurysms and 18 incompletely occluded aneurysms were analysed. Before treatment, inflow jets were found in 13 (72.2%) aneurysms in the incompletely occluded group and 34 (44.7%) in the completely occluded group ( = 0.292). After deployment of the pipeline embolisation device, inflow jets remained in nine (50%) aneurysms in the incompletely occluded group and nine (11.8%) in the completely occluded group ( = 0.001). In the incompletely occluded group, regions with inflow jets after treatment corresponded with the patent areas shown on follow-up digital subtraction angiography. The mean reduction ratios of velocity in the whole aneurysm and on the neck plane were lower in the incompletely occluded than in the completely occluded group ( = 0.003; = 0.017). Multivariate analysis revealed that the only independent risk factors for incomplete aneurysm occlusion were the reduction ratios of velocity (in the whole aneurysm, threshold 0.362, = 0.005; on the neck plane, threshold 0.273, = 0.015).
CONCLUSIONS
After pipeline embolisation device placement, reduction ratios of velocity in the whole aneurysm of less than 0.362 and on the neck plane of less than 0.273 are significantly associated with a greater risk of aneurysm incomplete occlusion. In addition, the persistence of inflow jets in aneurysms is associated with incomplete occlusion in the inflow jet area.
Topics: Adolescent; Adult; Aged; Blood Vessel Prosthesis; Child; Embolization, Therapeutic; Female; Hemodynamics; Humans; Hydrodynamics; Intracranial Aneurysm; Male; Middle Aged
PubMed: 31088244
DOI: 10.1177/1591019919849673 -
Circulation Apr 2014
Topics: Embolic Protection Devices; Embolization, Therapeutic; Humans; Plaque, Atherosclerotic; Saphenous Vein
PubMed: 24778124
DOI: 10.1161/CIRCULATIONAHA.114.010240 -
Journal of Neurointerventional Surgery Oct 2019Endosaccular flow disruption is an innovative method of treating wide-necked complex aneurysms. Currently four types of devices have obtained the CE mark for use within... (Review)
Review
Endosaccular flow disruption is an innovative method of treating wide-necked complex aneurysms. Currently four types of devices have obtained the CE mark for use within Europe. These are the Woven EndoBridge device (WEB), the Luna Aneurysm Embolization System, the Medina Embolic Device (Medtronic), and the Contour Neurovascular System. The aim of this article is to provide an overview of these devices and to summarize the evidence in the literature pertaining to the treatment of intracranial aneurysms with them.
Topics: Aneurysm; Drug Delivery Systems; Embolization, Therapeutic; Endovascular Procedures; Europe; Humans; Intracranial Aneurysm; Prosthesis Design; Treatment Outcome
PubMed: 31197026
DOI: 10.1136/neurintsurg-2018-014623 -
International Journal of Hyperthermia :... Nov 2017Pneumothorax is the most common complication following a pulmonary percutaneous radiofrequency ablation (RFA), and thoracic drainages are the most frequent causes of an... (Randomized Controlled Trial)
Randomized Controlled Trial
PURPOSE
Pneumothorax is the most common complication following a pulmonary percutaneous radiofrequency ablation (RFA), and thoracic drainages are the most frequent causes of an extended hospital stay. Our main objective was to show that the use of gelatin torpedoes may significantly decrease the number of chest tube placement.
MATERIALS AND METHODS
Seventy-three patients were prospectively included in this study and then randomised into two groups: 34 with embolisation and without 39 without embolisation. Each group was comparable for different pneumothorax risk factors.
RESULTS
There were 16 (47%) pneumothorax in Group A ("with embolisation"), which was significantly lower (p < .0001) than the 35 pneumothorax (90%) in Group B ("without embolisation"). The pneumothorax volume (p = .02) was significantly lower in Group A (22.7% average, standard deviation 15.6%) than in Group B (average 34.1%, standard deviation 17.1%). The number of drainages was significantly smaller in those with embolisation (3 drainages or 8%) than those without embolisation (25 drainages or 64%) (p < .001).
CONCLUSION
When using absorbable gelatin torpedoes, pulmonary RFA pathways embolisation significantly decreased the number of pneumothorax and thoracic drainages to the advantage of therapeutic abstention and exsufflation, non-invasive and functional operational techniques.
Topics: Aged; Catheter Ablation; Chest Tubes; Embolization, Therapeutic; Emphysema; Female; Gelatin; Humans; Lung; Male; Middle Aged; Pneumothorax
PubMed: 28540802
DOI: 10.1080/02656736.2017.1309578 -
European Journal of Vascular and... Jun 2020
Topics: Aneurysm, False; Arteries; Catheterization, Central Venous; Central Venous Catheters; Embolization, Therapeutic; Humans; Jugular Veins; Stents; Thyroid Gland; Treatment Outcome
PubMed: 32370919
DOI: 10.1016/j.ejvs.2020.03.046 -
Journal of Materials Chemistry. B Sep 2020Liquid formulations have a well-established role in therapeutic embolisation of blood vessels with the widespread use of cyanoacrylate glues, precipitating polymer... (Review)
Review
Liquid formulations have a well-established role in therapeutic embolisation of blood vessels with the widespread use of cyanoacrylate glues, precipitating polymer suspensions, sclerosing agents and viscous emulsions of oil and chemotherapeutic agents. There is currently an emerging market for next generation liquid embolics which aim to address some of the short-comings of the currently used products. These next generation systems use varying chemistries in their approach to formulate new systems including polymerising, precipitating and phase-transitioning mechanisms to form solidified masses in situ within the vasculature. Some of these emerging technologies have been developed to possess improved imaging properties such as inherent radiopacity, rather than relying on having to mixing with radiopaque materials such as tantalum powder and reduction of X-ray imaging artefacts (streaking). Others offer solvent-free formulations which gel on contact with blood thereby allowing precise control over gel formation during the embolisation process without the use of potentially toxic solvents. In this review, we discuss the role of liquid agents in therapeutic embolisation and the potential of emerging technologies under development for use in the next generation of embolics.
Topics: Animals; Chemical Precipitation; Embolization, Therapeutic; Gels; Humans; Phase Transition; Polymerization; Polymers
PubMed: 32813005
DOI: 10.1039/d0tb01576h -
La Radiologia Medica Mar 2007The aim of this study was to evaluate the effectiveness of the new Amplatzer vascular plug (AVP) for the occlusion of vascular abnormalities and peripheral vessels,...
PURPOSE
The aim of this study was to evaluate the effectiveness of the new Amplatzer vascular plug (AVP) for the occlusion of vascular abnormalities and peripheral vessels, especially those with a large diameter.
MATERIALS AND METHODS
The new device was used for the occlusion of five internal iliac arteries to prevent retrograde endoleak following endograft repair, three left subclavian arteries for the treatment of type II endoleaks after positioning thoracic aorta stent-grafts, one pulmonary arteriovenous malformation, one haemodialysis fistula in a patient with forearm oedema and one large gastric varix in a patient who had undergone transjugular intrahepatic portosystemic shunt (TIPS) for haemorrhage.
RESULTS
The five internal iliac arteries and the three left subclavian arteries were successfully occluded within 8 and 5 min, respectively. The pulmonary arteriovenous fistula was closed within 3 min and percutaneous oxygen saturation rose from 73% to 93%. The haemodialysis fistula was closed with one device within 4 min. The gastric varix was embolised with two AVPs and two coils within 12 min.
CONCLUSIONS
The AVP is an effective device for occluding large diameter vascular abnormalities and peripheral vessels. It is inexpensive and enables safe and low-risk embolisation, with saving of time and requiring only low X-ray dose.
Topics: Aortic Aneurysm, Abdominal; Aortography; Arteriovenous Fistula; Blood Vessel Prosthesis; Embolization, Therapeutic; Humans; Iliac Artery; Pulmonary Artery; Subclavian Artery; Tomography, X-Ray Computed; Vascular Diseases
PubMed: 17361373
DOI: 10.1007/s11547-007-0138-4 -
BMJ Case Reports Jan 2015This case outlines an unusual complication of coronary intervention, the likely mechanisms leading to this and possible retrieval options. It is the first case to the... (Review)
Review
This case outlines an unusual complication of coronary intervention, the likely mechanisms leading to this and possible retrieval options. It is the first case to the best of our knowledge reporting this complication. A 78-year-old Caucasian man underwent coronary stenting. During the procedure kinking and subsequent fracture of a non-compliant percutaneous transluminal coronary angioplasty (PTCA) balloon occurred. Injection of contrast down the guide to opacify the coronary arteries resulted in 'inflation' of the balloon with air, and embolisation of the inflated balloon into the proximal left anterior descending artery. The embolised balloon was retrieved by removal of the guide catheter and wire as a unit. The patient had a good angiographic outcome. This case highlights risks associated with usage of kinked balloons catheters, and describes for the first time to our knowledge, the inflation of a PTCA balloon with air from its shaft within the catheter, causing 'floatation' embolisation into the coronary artery.
Topics: Angioplasty, Balloon, Coronary; Coronary Angiography; Device Removal; Embolization, Therapeutic; Equipment Failure; Humans; Intraoperative Complications; Stents; Treatment Outcome
PubMed: 25576524
DOI: 10.1136/bcr-2014-205307 -
Techniques in Vascular and... Jun 2011Some degree of distal embolization likely occurs during all transcatheter interventional procedures. The clinical sequela is defined by the sensitivity of the target... (Review)
Review
Some degree of distal embolization likely occurs during all transcatheter interventional procedures. The clinical sequela is defined by the sensitivity of the target organ to segmental ischemia and the burden of embolic load. The spectrum of clinical consequences varies from the extremes of stroke and no-reflow phenomena in the carotid and coronaries, respectively, to silent renal insult following renal stenting. The clinical sequela of stroke and myocardial infarction in these most sensitive end-organ distributions led to the birth of embolic protection science. Over the past 2 decades embolic protection has matured and we now have a menu of devices to consider based on our specific patient clinical and anatomic needs. The goal of this narrative is to provide an update on protection device science and, more importantly, a very practical informal guide to the currently available technologies with emphasis on the pitfalls common to specific device families.
Topics: Embolic Protection Devices; Embolism; Endovascular Procedures; Humans; Prosthesis Design; Prosthesis Failure; Risk Assessment; Risk Factors; Treatment Outcome
PubMed: 21550513
DOI: 10.1053/j.tvir.2011.01.008